Volume 7, Issue 7, July – 2022
ISSN No:-2456-2165
Differences in the Level of Anxiety in the
Administration of Diazepam 2 Mg and 5 Mg in
Patients with Anxiety Levels Mild and Moderate to
Undergo Elective Surgery at the Haji Adam Malik
Center General Hospital Medan
Dhiny Yolanda Harahap 1, Achasanuddin Hanafie 2, Asmin Lubis 2
1.Resident Anesthesiology and Intensive Therapy USU Medical Faculty, H. Adam Malik Hospital Medan
2.Department of Anesthesiology and Intensive Therapy, USU Medical Faculty, H. Adam Malik Hospital, Medan
Abstract:-
Background : Anxiety or anxiety is one of the problems
that are often found in elective patients who will undergo
surgery. Anxiety is described as an uncomfortable feeling
filled with emotional tension, which is associated with
hemodynamic abnormalities as a consequence of
sympathetic, parasympathetic, and endocrine
stimulation. Anxiety is an emotional problem that will
also have a significant impact on anesthetic actions to
operative actions.
Objectives: This research aims for Comparing the
incidence of anxiety in patients with mild and moderate
levels of anxiety who will undergo elective surgery at Haji
Adam Malik General Hospital after administration of 2
mg and 5 mg diazepam tablets.
Methods: This study is an analytical study with an
experimental double-blind randomized clinical trial
design with the administration of 2 mg diazepam with 5
mg diazepam for anxiety in patients who will undergo
elective operative procedures. Perioperative anxiety
assessment using the APAIS score was then given
diazepam 2 mg or 5 mg in groups of patients with
predetermined mild and moderate levels of anxiety.
Results: in this study, the mean age of the patients was
39.2 ± 11.4 years. Most of the patients were female with 42
samples. Based on the characteristics of religion the most
Islam is 41 samples. Based on the characteristics of the
ethnic sample, the most Batak ethnic group was 34. the
level of anxiety in patients after administration of
Diazepam, subjects with mild anxiety levels in patients
after 10 hours of administration of diazepam 2 mg were
60 samples. the group that received diazepam 5 mg with
mild anxiety levels was 69 samples. Subjects with
moderate anxiety levels in the group receiving 2 mg
diazepam were 13 samples. The group receiving 5 mg
diazepam with mild anxiety levels was 4 samples.
Conclusion: There was no significant difference in the
administration of diazepam 2 mg or 5 mg in reducing the
level of anxietas in patients who were about to undergo
elective surgery.
Keywords:- APAIS Score , Perioperative Anxiety, Diazepam.
IJISRT22JUL1537 www.ijisrt.com
International Journal of Innovative Science and Research Technology
I. INTRODUCTION
Anxiety or anxiety is one of the problems that are often
found in elective patients who will undergo surgery. Anxiety
is described as an uncomfortable feeling filled with emotional
tension, which is associated with hemodynamic abnormalities
as a consequence of sympathetic, parasympathetic, and
endocrine stimulation. Anxiety is an emotional problem that
will also have a significant impact on anesthesia and surgery.
Anxiety that often occurs has various etiologies, both internal
and external to the patient himself. It has been confirmed for
more than four decades that most patients undergoing
procedures are very afraid of the anesthesia they will undergo,
surgery, pain and loss of consciousness during anesthesia.
Such persistent fear, although identified, has not been
formally applied in a large clinical setting as a preoperative
consideration. ( Adwas ,2020. Anissa, 2016)
A study conducted research that a certain level of
anxiety is a universal feature of the preoperative setting. The
incidence of anxiety varies from 8% to more than 80%.
Variation and incidence are described by several different
detection methods and tools for diagnosing preoperative
anxiety. The effect of anxiety is quite significant in several
studies; about 57.7% of patients experienced anxiety using
the APAIS scoring system. In a study using the same method,
it was also explained that a significant part of the patient's
anxiety experience before surgery, was mostly due to
concerns about the success of the operation, and in some
patients speaking, and educative measures could be an option
to reduce the occurrence of anxiety. Some degree of anxiety
is a natural reaction to threats that the patient cannot imagine
and the presence of potential threats from the environment
typical of the preoperative period. ( Akinsulore, 2017, Anissa,
2016)
Surgery is a treatment that uses an invasive method. The
surgical process includes preoperative , intraoperative and
postoperative phases. The preoperative phase in surgery is the
initial phase in the surgical process. This initial phase begins
when a decision is made for surgical intervention and ends
when the patient is sent to the operating table. The most
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common preoperative response is anxiety caused by
anesthesia, fear of pain, even the possibility of disability and
death. Preoperative anxiety is defined as an unpleasant
condition of anxiety due to illness, hospitalization and
planning for surgery and anesthesia to be performed. In some
patients, the manifestation of anxiety depends on several
factors, including age, gender and purpose of surgery,
anesthesia and previous experience with surgery and
anesthesia, and personal response to anxiety. High levels of
preoperative anxiety will pose risks associated with surgery
and the anesthetic required, including morbidity and
mortality. . (Akinsulore, 2017, Anissa, 2016)
The exact etiology of the incidence of preoperative
anxiety to date is highly variable. Some factors that also
greatly influence are age and gender, and as explained in the
previous paragraph regarding the experience of previous
operative procedures. These variations will affect how
patients receive the operative procedure to be performed, and
receive information about complications that will occur after
the procedure . (Akinsulore, 2017)
The situation before entering the operating room can
provide discomfort and anxiety that affect the patient's
mentality. This will affect the body's response to release
catecholamines so that it can lead to an increase in heart rate,
heart muscle contraction, arterial vasoconstriction, increased
blood sugar and others, these conditions can aggravate the
condition before entering the operating room.
Most patients awaiting elective surgery have anxiety.
The incidence of preoperative anxiety has been estimated to
vary from 11-80% in the adult sample. A 2007 study on
preoperative anxiety levels showed that from 40 samples of
respondents there were 16 samples or 40% who had an
anxiety level in the moderate category or 37.5% in the mild
category.
Management for preoperative anxiety is divided into
two, namely pharmacodynamics with anxiolytic agents and
non-pharmacodynamics with distraction methods. The
distraction method is by installing music, watching television,
relaxation and visitation from the doctor himself to provide
calm to the patient. For pharmacodynamic measures, several
preoperative medication options were found. Premedication
choices include benzodiazepines, diazepam and propranolol.
Several studies have also shown that the administration of
diazepam with different anxiolytic doses has a significant
effect on preoperative anxiolytic management. The study by
Mark Mitchel, et al collected some of the previously
conducted studies on the use of diazepam as an anxiolytic
agent. Wikinski et al, investigated the effect of diazepam 10
mg randomly assigned to patients who were divided into two
groups, one of which was a placebo group. Emotional level
examination was checked with STAI and VAS and found no
significant difference in MAP between the use of diazepam
10 mg and diazepam 5 mg. Another study also administered
diazepam 5 mg 30 minutes before surgery, and found a
decrease in anxiety 30 minutes after surgery. Diazepam at a
dose of 2 mg orally was also used as an antianxiolytic
medication in some studies. Until now, research is still
IJISRT22JUL1537 www.ijisrt.com
International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
ongoing on the most appropriate dose of diazepam for
preoperative anti-anxiolytics. The right dose of diazepam will
provide a significant difference in anxiety levels. (Micthel
Mark, 2019)
II. RESEARCH METHODS
A. Research methods
This study is an analytical study with an experimental
double-blind randomized clinical trial design with the
administration of 2 mg diazepam and 5 mg diazepam for
anxiety in patients who will undergo elective operative
procedures.
B. Place and time of research
The study was conducted at the Central Surgical
Installation of the Haji Adam Malik General Hospital,
Medan. Sample collection starts from February – March
2022.
C. Object of research
All adult elective surgery patients who will undergo
anesthetic and operative procedures at the Haji Adam Malik
General Hospital Medan.
D. Inclusion Criteria
The inclusion criteria for this study were adult patients
aged 18-65 years with an APAIS score <20 who were
scheduled to undergo surgical procedures, ASA I-II patients,
patients who agreed to participate in the study (Informed
consent).
E. Exclusion Criteria
Exclusion criteria were patients with a history of severe
anxiety before surgery and patients taking anti-anxiety drugs
before
F. How it works and data collection techniques
After obtaining approval from the ethics committee to
conduct research, the study began by collecting research
subjects according to inclusion and exclusion criteria. After
receiving an explanation of the objectives, benefits and
procedures of the study and signing an agreement to
participate in the study, interviews were conducted with
questionnaires to find out the data needed by the researcher.
Then the anxiety measurement was carried out using the
APAIS score before anesthesia was performed, the first
APAIS score was assessed 12 hours before diazepam was
given, and the second APAIS score was assessed 8 hours after
administration. Diazepam 2 mg or 5 mg was administered to
groups of patients with predetermined mild and moderate
levels of anxiety , intervention was administered 12 hours
before surgery. Then the APAIS score was assessed again
after 12 hours. Data were then recorded in each experimental
group . Performed data analysis with SPSS
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G. Data Management
The results of the data that have been collected are then
processed using the Kolmogorov Smirnov normality test. The
data obtained are normally distributed, a paired parametric
test will be carried out t-test to see the effect of giving
diazepam on APAIS scores.
H. Research Ethics
All research participants who were included in this
study, were given an explanation, in patients with decreased
awareness of family education is very necessary. About the
objectives, benefits, and risks of research as well as the
responsibilities of researchers. After they understand, they are
asked for approval by signing the agreement letter that has
International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
been provided. Every patient has the right to know the results
of the examination and may withdraw from the study if they
are not willing to continue the study. This research was
conducted with the approval of the Ethics Committee of the
Faculty of Medicine, University of North Sumatra
III. RESEARCH RESULT
A. Sample Characteristics
Sample on study this amount 146 sample which in
accordance with criteria inclusion and exclusion, sample
shared Becomes 2 group where group first get diazepam 2
mg and group to two get diazepam 5 mg. Characteristics
sample shown on Table 4.1.

Table 1 Sample Characteristics

Group p value
Characteristics Total
Diazepam 2 mg Diazepam 5 mg
n n
Gender
Man 31 35 66 0.67
Woman 42 38 80
Age (Mean ± SD) 39.8 ± 11.3 38.6±11.5 39.2 ± 11.4 0.88
Education
College 32 28 60
SENIOR HIGH SCHOOL 21 23 44 0,72
JUNIOR HIGH SCHOOL 18 19 37
SD 2 3 5

Table 1 shows the distribution of sample characteristics,
at This study had a mean patient age of 39.2 ± 11.4 years.
Most patients manifold sex woman of 42 samples. Based on
the characteristics of education, there are 32 samples found in
universities. The sample in this study whole planned for
operation elective without looking at technique anesthesia
with general anesthesia or with regional anesthesia and the
data obtained were homogeneous or normally distributed due
to the p value > 0.05.
B. Comparison of Anxiety in the Diazepam 2 mg Group
Before and After Treatment

Table 2 Comparison of anxiety in the Diazepam 2 mg group before and after treatment
Group Total
APAIS before Diazepam 2 mg
Treatment
Before After
Anxiety light 14 60 0.04
Anxiety currently 59 13 0.03
Total 73 73
* Paired T Test

Based on table 2 level anxiety on patient after gift
Diazepam 2 mg There were 14 samples of mild anxiety level
and 60 samples of mild anxiety level after administration of
diazepam 2 mg with a P value of 0.04 there was a significant
difference between anxiety levels before and after
administration of 2 mg diazepam. Subjects with moderate
levels of anxiety in the group receiving diazepam 2 mg as
much 59 samples and after administration of diazepam 2 mg
obtained moderate anxiety levels 13 samples with p value <
0.03, there was a significant difference between moderate
anxiety levels before and after administration of diazepam 2
mg

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Volume 7, Issue 7, July – 2022
C. Comparison of Anxiety in the Diazepam 5 mg Group Before and After Treatment
Table 3 Comparison of anxiety in the Diazepam 5 mg group before and after treatment
Group
APAIS before Treatment
Before
Anxiety light 9 69
Anxiety currently 64
Total 73
* Paired T Test
Based on table 3 levels anxiety on patient after gift
Diazepam 5 mg 9 samples of mild anxiety level and after
administration of 5 mg diazepam mild anxiety level of 69
samples with a P value of 0.04 there was a significant
difference between anxiety levels before and after 5 mg
diazepam administration. Subjects with moderate anxiety
level in the group that received diazepam 5 mg as much 64
sample and after administration of diazepam 5 mg obtained
moderate anxiety level 4 samples with p value < 0.05 there
was a significant difference between moderate anxiety level
before and after administration of diazepam 5 mg
IV. DISCUSSION
This study is to determine the difference in anxiety
levels on patient which get diazepam 2 mg and diazepam 5
mg with use scoring APAIS on patient which will undergo
surgery elective in RSUP H. Adam Malik Medan. This study
consisted of 2 groups where each group consisted of 73
samples, in this study based on the distribution of sample
characteristics, in This study had a mean patient age of 39.2
± 11.4 years. Most patients manifold sex woman of 42
samples in the 2 mg diazepam group and at least 31 samples
in the male diazepam 2 mg group. Based on the characteristics
of Religion most many Islam was 41 samples in the 5 mg
diazepam group. Based on the characteristics of the ethnic
sample, the most Batak tribes are 34. Based on the
characteristics of education, the sample is mostly found in
universities. The sample in this study whole planned for
operation elective without looking at technique anesthesia
with general or regional anesthesia.
This research was carried out because so far to reduce
preanxiety always use diazepam 5 mg, while for the dose of
diazepam itself is an incremental dose where the dose given
starts from dose which smallest (2 mg), on study for use drug
this previously only limited to administration of 5 mg only
without judging the effect produced to reduce anxiety at
lower doses, and has not There are studies that assess the
effectiveness of giving diazepam 2 mg and 5 mg in reducing
anxiety in similar elective preoperative patients who
conducted in Indonesia.
Anxiety preoperative defined as condition which no
pleasure from restlessness and tension due to illness,
hospitalization and planning for surgery and anesthesia
conducted. Some patient manifestations of anxiety depends
on several factors,including age gender, type of anesthesia,
surgery experience and anesthesia previously, as well as
IJISRT22JUL1537 www.ijisrt.com
International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Total
Diazepam 5 mg
After
0.04
4 0.03
73
response personal to Anxiety. Level High preoperative
anxiety will increase the risk associated with surgery and drug
anesthesia which needed including morbidity and mortality (
Batista, MM , 2014). Anxiety causes an increase in
catecholaminestachycardia, hypertension and hemodynamic
instability, arrhythmiasand a high pain threshold that persists
well into the postoperative period. Indicator biological which
could reliable for reaction Anxiety is marker which valuable
in study psycho-physiological and practice clinical (Paryanto,
2009).
Anxiety can be measured by measuring the level of
Anxiety according to the tool measuring Anxiety which This
is called APAIS ( Amsterdam Preoperative Anxiety and
Information Scale ). Scale APAIS is measurement Anxiety
specifically designed to measure the anxiety of pre -
anesthesia and preoperative patients.
This study was followed by 146 samples of patients who
have met the criteria inclusion, divided into two groups with
the same number, each each amount 73 sample. Where
study this have average age patienthad a mean patient age
of 39.2 ± 11.4 years. Most patients manifold sex woman with
percentage 54.8%. Patient most many Islam with a
percentage of 54.8%, with the most ethnic Batak tribes that is
45.2%. Most patients with tertiary education are 41.2%. The
sample in this study whole planned for operation elective
without looking at technique anesthesia with general or
regional anesthesia.
Study previously Anita D, et al, on year 2017 To do
study where as many as 40 patients met the inclusion criteria.
Effectiveness diazepam and placebo. There was a decrease in
Alpha Amylase levels after administration of diazepam but
not significant (p = 0.117) while at group placebo obtained
enhancement rate Alpha Amylase by significant (p=0.000).
In addition, the results showed that there were differences in
the levels of Alpha Amylase after intervention between
second group (p= 0.040) rate Alpha Amylase group diazepam
more low compared to with group placebo. Diazepam 5 mg
orally preoperatively effectively reduces salivary alpha
amylase compared to with placebo on patient which will
conducted operation tumor breast.
In this study, dizepam 2 mg and 5 mg were
administered. in patients who will undergo elective surgery
with anxiety levels medium and heavy. Diazepam is given the
night before surgery and assessed on the APAIS scale, then
reassessed the APAIS scale after 10 hours gift drug diazepam.
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Results analysis use test T pair showed that there was a
significant difference in anxiety levels in patients with 2 mg
and 5 mg diazepam. This researchnot assess in detail about
the side effects that occur due to administration diazepam by
details.
V. CONCLUSION
There was no significant difference in the administration
of diazepam 2 mg or 5 mg in reducing anxiety levels in
patients who will undergo elective surgery . There is drop
level anxiety on patient which get diazepam 2mg with use
scoring APAIS on patient which going to have surgery
elective. There is drop level anxiety on patient which get
diazepam 5 mg using APAIS scoring in patients who will
undergoing elective surgery.
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